Abstract
We used questionnaire data collected at intake from 979 parents and guardians of 6-year-old children to 18-year-old children referred to a private outpatient mental health clinic to build on and extend current views of caregiver strain and its relationship to children’s behavioral and emotional problems. First, we offered evidence for the validity of a measure of attachment strain, referring to strains in caregivers’ positive feelings towards their child; and second, we assessed whether parent-child interactions might help to account for robust relationships between child problems and caregiver strain identified in prior studies. Findings were consistent with our conceptualization of attachment strain as distinct from but related to dimensions of strain identified in prior research, and as an especially severe, outwardly directed form of subjective strain associated with caring for a child with especially severe problems in behavioral and emotional regulation. Multiple regression analysis showed that child problems and parent-child interactions accounted for 31 to 42 % of the total variance in caregiver strain. Commonality analysis indicated that approximately half of the explained variance in each dimension was “shared.” The unique contribution of child problems, however, overshadowed the unique contribution of parent-child interactions in predicting objective and subjective internalized strain whereas the opposite was true for subjective externalized and attachment strain. We suggest that child-problem-focused treatment strategies may be especially helpful in addressing caregivers’ objective and subjective internalized strain whereas strategies designed to improve the quality of parent-child interactions may be especially helpful in alleviating caregivers’ subjective, outwardly directed experiences of strain.
Similar content being viewed by others
References
Accurso, E. C., Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., & Baker-Ericzen, M. J. (2015). Factors contributing to reduced caregiver strain in a publicly funded child mental health system. Journal of Emotional and Behavioral Disorders, 23(3), 131–143. doi:10.1177/1063426614532948.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. DSM-V
Barkley, R. A., & Benton, C. M. (1998). Your Defiant Child. New York, NY: Guilford.
L. Bickman, M. Riemer, E. W. Lambert, S. D. Kelley, C. Breda, S. E. Dew, A. M. Brannan, A. R. Vides de Andrade (Eds.) (2007). Manual of the Peabody treatment progress battery. Nashville, TN: Vanderbilt University. http://peabody.vanderbilt.edu/ptpb
Brannan, A. M. (2003). Ensuring effective mental health treatment in real-world settings and the critical role of families. Journal of Child and Family Studies, 12(1), 1–10. doi:10.1023/A:1021385223674.
Brannan, A. M., Athay, M. M., & Vides de Andrade, A. R. (2012). Measurement quality of the Caregiver Strain Questionnaire-Short Form 7 (CGSQ-SF7). Administration and Policy in Mental Health and Mental Health Services Research, 39(1-2), 51–59. doi:10.1007/s10488-012-0412-1.
Brannan, A. M., & Heflinger, C. A. (2005). Child behavioral health service use and caregiver strain: Comparison of managed care and fee-for-service Medicaid systems. Mental Health Services Research, 7(4), 197–211. doi:10.1007/s1120-005-7452-z.
Brannan, A. M., & Heflinger, C. A. (2006). Caregiver, child, family, and service system contributors to caregiver strain in two child mental health service systems. The Journal of Behavioral Health Services & Research, 33(4), 408–422. doi:10.1007/s11414-006-9035-1.
Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5(4), 212–222. doi:10.1177/106342669700500404.
Brannan, A. M., Heflinger, C. A., & Foster, E. M. (2003). The role of caregiver strain and other family variables in determining children's use of mental health services. Journal of Emotional and Behavioral Disorders, 11(2), 77–91. doi:10.1177/106342660301100202.
Bussing, R., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003a). Child temperament, ADHD, and caregiver strain: Exploring relationships in an epidemiological sample. Journal of the American Academy of Child & Adolescent Psychiatry, 42(2), 184–192. doi:10.1097/00004583-200302000-00012.
Bussing, R., Zima, B. T., Gary, F. A., Mason, D. M., Leon, C. E., Sinha, K., & Garvan, C. W. (2003b). Social networks, caregiver strain, and utilization of mental health services among elementary students at high risk for ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 42(7), 842–850. doi:10.1097/01.CHI.0000046876.27264.BF.
Dykstra, T.R., Roubal, K.C., Frank, S.J., Breitzer, G.M., & Godin, J.L. (2015). Agreement and disagreement in adolescent and parent reports of adolescent problems: Unshared variance is important too. Poster session presented at the 123rd Annual Convention of the American Psychological Association, Toronto, Ontario.
Evans, S. W., Sibley, M., & Serpell, Z. N. (2009). Changes in caregiver strain over time in young adolescents with ADHD. Journal of Attention Disorders, 12(6), 516–524. doi:10.1177/1087054708322987.
Foster, E. M. (1998). Does the continuum of care influence time in treatment? Evidence from the Fort Bragg Evaluation. Evaluation Review, 22(4), 447–469. doi:10.1177/0193841X9802200402.
Frank, S. J., Paul, J. S., Marks, M., & Van Egeren, L. A. (2000). Initial validation of the functional impairment scale for children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39(10), 1300–1308. doi:10.1097/00004583-200010000-00018.
Frank, S. J., Van Egeren, L. A., Fortier, J. L., & Chase, P. (2000). Structural, relative, and absolute agreement between parents’ and adolescent inpatients’ reports of adolescent functional impairment. Journal of Abnormal Child Psychology, 28(4), 395–402. doi:10.1023/A:1005125211187.
Glasser, H., & Easley, J. (2008). Transforming the difficult child: The nurtured heart approach. Tucson, AZ: Center for the Difficult Child Publications.
Greene, R. W. (2014). The Explosive Child: A new approach for understanding and parenting easily frustrated, chronically inflexible children. New York, NY: HarperCollins.
Heflinger, C. A., Simpkins, C. G., Scholle, S. H., & Kelleher, K. J. (2004). Parent/caregiver satisfaction with their child’s Medicaid plan and behavioral health providers. Mental Health Services Research, 6(1), 23–32. doi:10.1023/B:MHSR.0000011254.95227.c3.
Hibbs, E. D. & Jensen, P. S. (Eds.) (2005). Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice. 2nd ed. Washington, DC: American Psychological Association.
Hodges, K. (1994). The Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Department of Psychology, Eastern Michigan University. Unpublished measure
Hodges, K., Bickman, L., Kurtz, S. & Reiter, M. (1992). A multidimensional measure of level of functioning for children and adolescents. In A. Algarin & R. M. Friedman (Eds.), A system of care for children’s mental health: Building a research base. Tampa, FL: Florida Mental Health Institute, University of South Florida.
Kang, E., Brannan, A. M., & Heflinger, C. A. (2005). Racial differences in responses to the caregiver strain questionnaire. Journal of Child and Family Studies, 14(1), 43–56. doi:10.1007/s10826-005-1112-1.
Kenny, D. A. (2016). Mediation. Retrieved from http://davidakenny.net/cm/mediate.htm#SE.
Leibenluft, E. (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of Psychiatry, 168(2), 129–142. doi:10.1176/appi.ajp.2010.10050766.
McDonald, T. P., Poertner, J., & Pierpont, J. (1999). Predicting caregiver stress: An ecological perspective. American Journal of Orthopsychiatry, 69(1), 100–109. doi:10.1037/h0080385.
Osborne, J. (2002). Notes on the use of data transformations. Practical Assessment, Research & Evaluation, 8(6), retrieved from http://PAREonline.net/getvn.asp?v=8&n=6
Papolos, D., Hennen, J., Cockerham, M. S., & Lachman, H. (2006a). A strategy for identifying phenotypic subtypes: Concordance of symptom dimensions between sibling pairs who met screening criteria for a genetic linkage study of childhood-onset bipolar disorder using the child bipolar questionnaire. Journal of Affective Disorders, 99, 27–36. doi:10.1016/j.jad.2006.08.014.
Papolos, D., Hennen, J., Cockerham, M. S., Thode, H. C., & Youngstrom, E. A. (2006b). The child bipolar questionnaire: A dimensional approach to screening for pediatric bipolar disorder. Journal of Affective Disorders, 95, 149–158. doi:10.1016/j.jad.2006.03.026.
Paul, J. A. (1997). Validational study of the Functional Impairment Scale for Children and Adolescents. Poster session presented at the Biennial Meetings of the Society for Research on Child Development, Washington DC.
Ray-Mukherjee, J., Nimon, K., Mukherjee, S., Morris, D. W., Slotow, R., & Hamer, M. (2014). Using commonality analysis in multiple regressions: a tool to decompose regression effects in the face of multicollinearity. Methods in Ecology and Evolution, 5, 320–328. doi:10.1111/2041-210x..12166.
Sales, E., Greeno, C., Shear, M. K., & Anderson, C. (2004). Maternal caregiving strain as a mediator in the relationship between child and mother mental health problems. Social Work Research, 28(4), 211–223. doi:10.1093/swr/28.4.211.
Sanders, M. R., Dadds, M. R., Johnston, B. M., & Cash (1992). Childhood depression and conduct disorder: I. Behavioral, affective, and cognitive aspects of family problem-solving interactions. Journal of Abnormal Psychology, 101(3), 495–504. doi:10.1037/0021-843X.101.3.495.
Schrock, M., & Woodruff-Borden, J. (2010). Parent-child interactions in anxious families. Child and Family Behavior Therapy, 32(4), 291–310. doi:10.1080/07317107.2010.515523.
Townsend, A. L., & Franks, M. M. (1995). Binding ties: Closeness and conflict in adult children’s caregiving relationships. Psychology and Aging, 10(3), 343–351. doi:10.1037/0882-7974.10.3.343.
Tsai, K. H., Yeh, M., & Slymen, D. (2015). Strain in caring for youths meeting diagnosis for disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 23(1), 40–51. doi:10.1177/1063426613503498.
Van Egeren, L. A., Frank, S. J., & Paul, J. S. (1999). Daily behavior ratings among child and adolescent inpatients: The abbreviated child behavior rating form. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1417–1425. doi:10.1097/00004583-199911000-00017.
Vaughan, E. L., Feinn, R., Bernard, S., Brereton, M., & Kaufman, J. S. (2012). Relationships between child emotional and behavioral symptoms and caregiver strain and parenting stress. Journal of Family Issues, 34(4), 534–556. doi:10.1177/0192513X12440949.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Frank, S.J., Roubal, K.C., Breitzer, G.M. et al. Separating the Effects of Child Problems and Parent-Child Interactions on Caregiver Strain. J Child Fam Stud 26, 248–261 (2017). https://doi.org/10.1007/s10826-016-0560-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-016-0560-0